Issue link: https://viewer.e-digitaledition.com/i/1421339
The researchers fou nd t hat a mon g o b e s e i n d i v i d u a l s with a significant history of major cardiac events, bariatric surger y led to a substa ntia l reduction in the likelihood of future events a nd improved mor ta lity, even a mong those in need of a hea r t or lung tra nspla nt. W herea s prev ious st udies found a n improvement of approximately 30%, the M ACE study found a reduction twice as high. The implications a re clea r. "In our view, such patients — if they meet su r g ica l cr it er i a — shou ld be considered for ba riatric surger y," says Mehra n A nva ri, MD, PhD, Professor of Surger y at McMaster Universit y in Ha milton, Onta rio. According to Dr. A nva ri, the M ACE s t udy es t a bl i shes t he need t o h ave a l a r ge , mu lt ic ent er, r a n dom i z e d , controlled study to fur ther look at the ef f icacy of ba r iatr ic surger y i n t h is popu lat ion . To t hat end, he a nd h is colleag ues are working to secure fund- ing a nd hope to begin their study soon. Physicia ns interested in pa r ticipating should contact Dr. A nva ri at a nva ri@ mcmaster.ca . CUTTING SUBSEQUENT MI RISK IN HALF An observational study in Sweden found that metabolic surger y plays a role in seconda r y prevention of myoca rdia l infa rction. In the study, resea rchers demonstrated that metabolic surger y has no sig nif ica nt impact on stroke or newly developed atria l f ibrillation. It does, however, reduce the risk of death sig nif ica nt ly a nd decrea ses new MI in patients with severe obesit y a nd a persona l histor y of MI. "I anticipated that the surger y would have an effect, but not to the magnitude that we found," says Erik Näslund, MD, PhD, Professor of Surger y, Department of Clinical Sciences, Danderyd Hospital, Ka rolinska Institutet in Stock holm, Sweden. Mov ing for wa rd, Dr. Nä slund la id out three steps to fur ther va lidate the study 's f indings. 1. Fur ther resea rch to determine if t here is a dif ference in surg ica l risk i n pat ient s w it h severe obesit y a nd previous MI. 2 . Det er m i ne i f a l l pat ient s w it h s e v e r e o b e s i t y a n d p r e v i o u s M I benef it f rom weig ht-loss surger y or whether some patients a re poor surg i- ca l ca ndidates. 3 . Pe r f o r m a r a n d o m i z e d c l i n i- ca l tria l. Additiona lly, Dr. Nä slund suspects those with Ty pe 2 diabetes a nd prior MI may have the greatest benef it from ba riatric surger y, as it addresses both issues. Future resea rch will be neces- sa r y to va lidate this theor y. IMPROVING CHF WITH BARIATRICS Within the morbidly obese population, " t he r isk for hea r t fa i lure increa ses from 30% up to 100%," says Collin E.M. Brathwa ite, MD, MS, FACS, Professor and Chair of the Department of Surgery, Ch ief of t he Div i sion of M i n i m a l ly Invasive and Bariatric Surger y at N Y U Long Isla nd School of Medicine a nd Director of the Metabolic and Bariatric Su r ger y P rog r a m at N Y U L a n gone Hospita l–Long Isla nd. B a s e d on r e s e a r c h t h a t s h o w e d positive effects of ga stric by pa ss a nd sleeve gastrectomy on obese rats with diabetes a nd persona l experience with obese CH F patients, Dr. Brat hwa ite a nd col lea g ues launched resea rch to investigate whether ba riatric surger y is a sa fe option for obese indiv idua ls with CHF. "Currently, ba riatric surger y is only being utilized in 1% of the population who may benefit from it," Dr. Brathwaite says. " The study suggests … ba riatric su rger y ca n be per for med sa fely i n patients with a histor y of CHF." Encou ra g i n g a s t h i s new s i s , t he study was limited. It was retrospective in design (CHF patients who underwent ba riatric surger y over 11 yea rs were st ud ied), a nd t here were not hemo- dy na mic pa ra meters associated with CHF diagnosis made for ever y patient. Despite this, Dr. Brathwaite insists that morbidly obese individua ls with CHF ca n benef it from metabolic surger y. For optima l results, he specif ies, they must be prepared for surger y with opti- mized conditions and provided surgica l inter vention by a n ex perienced tea m using minima lly invasive techniques. PROVIDING A BRIDGE TO TRANSPLANT A novel path is being paved in bariatrics t hat is i mprov i ng t he lives of t hose awa iting a hea r t or lung tra nspla nt. Cer ta in hospita ls now use ba riatric surger y in tandem with the implanta- tion of a left ventricular assist device (LVA D) as a bridge to transplantation. Early results documented on the Thomas Jefferson University website indicate positive outcomes. "Despite being at higher risk for heart disea se, when patients w ith obesit y develop heart failure, their road to trans- plant can be frustrating," says Vakhtang Tchantchaleishvili, MD, cardiac surgeon and Assistant Professor of Surger y at Thomas Jefferson University. "Our study shows that weight reduction surger y can help patients both lose weight and qua lify for heart transplant, for which they were previously not eligible due to excessive weight." The patients were divided into two groups. One underwent both procedures at once, a nd the other under went the procedures a n avera ge of t wo yea rs apart. Both groups had positive results. n M D N E W S . C O M /// M D N E W S C E N T R A L N E W Y O R K ■ 2 0 21 1 3